Provider Demographics
NPI:1962289728
Name:WRIGHT, SHAMORA
Entity type:Individual
Prefix:
First Name:SHAMORA
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32652 PUEBLO TRL UNIT 2
Mailing Address - Street 2:
Mailing Address - City:CATHEDRAL CTY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-4599
Mailing Address - Country:US
Mailing Address - Phone:904-401-4948
Mailing Address - Fax:
Practice Address - Street 1:32652 PUEBLO TRL UNIT 2
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CTY
Practice Address - State:CA
Practice Address - Zip Code:92234-4599
Practice Address - Country:US
Practice Address - Phone:904-401-4948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty